The PICO(T) framework is well known among researchers as an instrumental approach under which one may summarize a research question that seeks to identify and explore the results of a particular therapeutic intervention. The mnemonic PICO(T) stands for population (P), which is the sample under study; an intervention (I), which is the treatment identified; a comparison (C), which involves a different intervention to compare the chosen intervention to; an outcome (O) which represents the result to be measured to determine the effectiveness of the chosen intervention, and a time frame (T) which is the duration to achieve the desired outcome. This paper will leverage the PICO(T) framework in discussing an intervention towards type 2 diabetes mellitus (T2DM). Below is the central question this essay explores.
PICO(T) Question
Among middle-aged men with type 2 diabetes (P), is a non-pharmacologic approach such as physical activity and/or exercise (I) better, compared to pharmacologic interventions (C), as the primary intervention for glycemic control (O)?
Use of the PICO(T) Approach When Caring for Patients with T2DM
The research question above highlights one care intervention today being regarded as an essential care practice for patients with diabetes mellitus. Physical activity has shown tremendous positive results in helping patients with T2DM control their blood glucose levels. From the question above, we note that the population under study is middle-aged men with T2DM, and the intervention is physical activity. The intervention of choice is a non-pharmacological one and is being compared to pharmacological interventions/drug therapy. Lastly, the outcome desired by exploring this research question is identifying if non-pharmacological interventions can substitute drug therapy for short- and long-term glycemic control.
Identification of Sources of Evidence
A behemoth of research studies exists in which researchers extensively explore how physical activity can be of help among T2DM patients. For this essay, we explore four research articles that focus on physical exercise as an alternative or at least an adjunct to pharmacological interventions. Below is a discussion of the evidence-based findings from those four research articles.
Explanation of Findings
Syeda et al. (2023) find that a comprehensive lifestyle program incorporating either 150 minutes per week of moderate-intensity or 75 minutes per week of vigorous-intensity aerobic exercise has tremendous positive results for improving patients’ quality of life with T2DM. Syeda et al. (2023) advise that such aerobic activity increases insulin sensitivity, vascular function, reduction in body fat, and overall aerobic fitness in a person with T2DM. However, Syeda et al. (2023) assert that such exercise must be continuous and spread throughout the week with no more than two consecutive days without any exercise. More so, other exercise types such as resistance training, high-intensity interval training, and breaks in sedentary behavior can help improve a patient’s glycemic control and protect against other complications such as cardiovascular disease.
Like Syeda et al. (2023), Shah et al. (2021) systematically reviewed and performed a meta-analysis of previous literature focusing on the therapeutic impacts of exercise and general physical activity on glycemic control. These researchers identified 32 eligible studies for a systematic review and 26 for the meta-analysis. Almost all of the 32 studies had one common result: physical activity or exercise improved quality of life and optimization of glycemic control among patients with T2DM (Shah et al., 2021). These researchers conclude that regular exercise involving aerobic and resistance training is beneficial and can be used as an adjunct therapy to pharmacological alternatives since it enhances glucose metabolism and improves the insulin sensitivity of diabetic patients (Shah et al., 2021).
Harrington & Henson (2021) concede with Syeda et al.’s (2023) argument that weekly physical activity of either 75 minutes of vigorous-intensity or 150 minutes of moderate-intensity positively impacts overall body health and physical functions. Nonetheless, Harrington and Henson (2021) add that supplementing any exercise regimen with sessions involving resistance, balance, and flexibility training leads to healthier status and improved quality of life. In sum, these authors concede that for a patient with T2DM, any form of physical activity and reduced sedentary behavior will lead to better management of the condition and reduced health risks.
Lastly, Savikj & Zierath (2020) add to this research with literature on why individuals with T2DM ought to take up training exercises as athletes do. Savikj & Zierath (2020) assert that despite the precise exercise regimen that offers the best benefits for metabolic adaptations, it is still imperative that type 2 diabetics engage in regular physical exercise of different intensity, frequency, and modality. This will ultimately aid glycemic control, metabolism, and overall body fitness.
Relevance of Chosen Findings
The articles discussed above provide critical perspectives on why non-pharmacological interventions such as physical activity should be incorporated into the care provided to individuals with T2DM. Syeda et al. (2023) primarily offer an in-depth exploration of T2DM prevention and management. They explore how aerobic and resistance exercise and high-intensity interval training aid in glycemic control. The article also delves into the need to decrease sedentary activity as it harbors more health risks. Further, the authors explore in detail the need for timing exercises relative to the time of the day and meals, whereby they find that different exercises offer the best benefits during different times of the day and before or after having a meal.
On the other hand, Shah et al. (2021) offer a review of diverse prior literary materials that dissect the issue of the benefits of physical activity for people with diabetes. This resource combines a systematic review and meta-analysis of various research articles. Notably, this resource gives the common conclusion between all the studies reviewed: exercise commonly results in optimizing glycemic control and improving quality of life.
Additionally, Harrington & Henson (2021) and Savikj & Zierath (2020) offer an explanatory perspective of why there is a need for type 2 diabetics to be actively and regularly involved in exercise. Both articles extensively discuss the ins and outs of physical activity among diabetic patients. They leverage existing research to describe what one needs to understand about physical activity and diabetes.
Conclusion
In sum, non-pharmacological interventions for managing T2DM can and have been utilized since they have positive results. The PICO(T) research question developed above has enabled this essay to explore leveraging physical activity in place of pharmacological intervention in managing T2DM. The articles used for this research have supported this endeavor and provide reliable, pertinent, and satisfactory information.
References
Harrington, D. & Henson, J. (2021). Physical Activity and Exercise in the Management of Type 2 Diabetes: Where to Start? Practical Diabetes. https://doi.org/10.1002/pdi.2361
Savikj, M., Zierath, J.R. (2020). Train like an Athlete: Applying Exercise Interventions to Manage Type 2 Diabetes. Diabetologia 63, 1491–1499. https://doi.org/10.1007/s00125-020-05166-9
Shah, S. Z. A., Karam, J. A., Zeb, A., Ullah, R., Shah, A., UI Haq, I., Ali, I., Darain, H. & Chen, H. (2021). Movement is Improvement: The Therapeutic Effects of Exercise and General Physical Activity on Glycemic Control in Patients with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Diabetes Ther 12, 707–732. https://doi.org/10.1007/s13300-021-01005-1
Syeda, U. S. A., Battillo, D., Visara, A. & Malin, S. K. (2023). The Importance of Exercise for Glycemic Control in Type 2 Diabetes. American Journal of Medicine Open, Vol. 9. https://doi.org/10.1016/j.ajmo.2023.100031
write